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Chapter-40 Hepatitis C Virus and Liver Transplantation

BOOK TITLE: Liver Transplantation

Author
1. K Dilip Chakravarty
2. Lee WC
3. Jan YY
4. Lee Po-Huang
ISBN
9788184487701
DOI
10.5005/jp/books/10445_40
Edition
1/e
Publishing Year
2010
Pages
8
Author Affiliations
1. Chang Gung Memorial Hospital (Linkou), Taipei, Taiwan (ROC)
2. Chang Gung Transplantation Institute (Linkou), Chang Gung University, Taipei, Taiwan (ROC)
3. Chang Gung Memorial Hospital (Linkou), Chang Gung University, Taipei, Taiwan (ROC)
4. National Taiwan University Hospital, Taipei, Taiwan (ROC)
Chapter keywords

Abstract

There is rapid increase in the number of patients with HCV infection undergoing LTX. HCV is currently accounting for >50% of liver transplants both in USA and Europe. In Asian countries, Japan has more incidence of HCV as compared to others like China, Taiwan or Korea where HBV is more. Chronic HCV infection with cirrhosis is now the most common indication for OLT in the USA and Western Europe. Recurrence of HCV infection after LTX is almost universal and thus measurement of serum HCV RNA is not helpful. Reinfection of the allograft may occur either from extra hepatic sites or from circulating virus pre-operatively. Recurrent infection commonly leads to hepatitis, and is less aggressive than the recurrent hepatitis B after transplant. Increased risk of graft loss is noticed following recurrent hepatitis C infection. Genotype 1b and 4 are more virulent as compared to others. Recurrent HCV infection presenting as acute lobular hepatitis is documented in 75% of liver biopsy by 4 months after transplantation. 70 to 80% of recurrent HCV infection develops as mild disease. Progression to cirrhosis occurs in 6 to 23% of patients at a median of 3 to 4 years post-LTX. 20 to 30% of patients can have rapidly progressive disease; cirrhosis and decompensation at 5 years follow up leading to allograft failure and need for re-transplantation in 10 % of patients.

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